Loss of Haitian caregivers leaves void NY nursing homes, patients will ‘struggle to fill’

At the close of business on Monday last week Cabrini nursing home in Westchester had to lay off seven full-time employees, all of them Haitian caregivers freshly ineligible to work because of a Trump administration policy shift on immigration.

The workers were mostly nursing assistants who fed, bathed and groomed elderly residents, said Simone Smith, who heads the organization’s human resources department. They were usually the first person the residents saw when they woke up in the morning and the last person they saw before going to bed, she said.

The departures left “a void in staffing that we’re going to struggle to fill,” Smith said. “It’s not easy to acquire staff in this industry. One, because typically you don’t have a lot of prospective employees knocking down your doors to work at a nursing home.”

Many nursing homes, homecare agencies, and other medical facilities are in a similar bind, scrambling to fill vacancies created by the Trump administration’s decision to end a humanitarian relief program for Haitian immigrants allowing them to live and work legally in the United States because of dire conditions back home.

The end of TPS could have life-altering implications for hundreds of thousands of Haitian immigrants throughout New York and the country who, with a stroke of a pen, find their immigration status in limbo. But the Trump administration’s policy shift also has implications for a healthcare system that is heavily dependent on immigrant caregivers.

Immigrants make up 30% of the country’s direct care workers, which include home health aides, personal care aides, and nursing assistants who work in nursing homes, residential care facilities, and home health environments, according to a July study by KFF, formerly known as the Kaiser Family Foundation. And that share is especially high in New York state, where the study found 60% of direct care workers are immigrants.

Moreover, a significant portion of healthcare workers are TPS recipients — over 15%, according to a study published last year in the Journal of the American Medical Association. Across the country, 6% of the nation’s direct care workers are Haitian, according to the KFF study.

“ There is real concern about this court decision and its implications on the provision of care in nursing homes and assisted living facilities throughout New York,” said Stephen Hanse, the president and CEO of the New York State Health Facilities Association, which represents over 450 nursing homes and assisted living providers across the state.

“New York state is in a long-term care workforce crisis,” Hanse added, noting that the over-65 population is the fastest-growing age group in the state. “We are struggling to recruit and retain long-term care workers… So this decision has the potential to further deplete our workers who provide direct care to residents, and really our most vulnerable residents.”

Karen Lipson, with LeadingAge NY, a group that represents some 400 nonprofit and government-sponsored long-term care and aging services providers, said it’s difficult for the organizations she represents to fill and replace positions, in part because the roles require significant training.

“Most of our members have open positions, and this will just add to the number of open positions that they have to fill,” Lipson said.

The end of TPS comes amid a nationwide shortage of home health aides, personal care aides, nursing assistants and other long-term and eldercare workers. The humanitarian immigration protection is for individuals from countries deemed too dangerous to return to because of war, disease, environmental disaster or some other “extraordinary and temporary” condition.

The Supreme Court in June cleared the way for the Trump administration to end TPS for over 300,000 Haitians across the country. The protections officially expired on July 27. That includes protections for some 40,000 Haitians in New York state, according to data compiled by Phillip Connor, research fellow at Princeton University. On Wednesday, a federal district court judge, guided by the high court’s ruling, officially allowed TPS to end for Haitian immigrants.

The administration contends the program has been abused and the protections are no longer necessary — even as it warns U.S. citizens not to travel to Haiti because of civil unrest in that country. Immigration advocates say the White House’s policy shift on TPS is merely a part of the administration’s broad crackdown on both legal and unlawful immigration.

Lipson said the end of TPS for Haitians and other groups — the White House has targeted nationals from another 10 or so countries — will disrupt longtime caregiving relationships between workers and patients. Providers become familiar with their client’s needs, including the foods they prefer, the music they like, and the inside jokes they share, she said.

“Especially for older adults who may be suffering with cognitive impairments, the familiarity and the continuity is so important,” Lipson said. “ You can’t replace that. I mean, you can over time, but it’s not something you can replace immediately.”

Sabine French, who lives in Queens, said ahead of a Wednesday district court ruling that her 91-year-old mother, a permanent resident from Haiti who has vision problems, arthritis and other health issues, would be devastated without her caregiver, a Haitian immigrant losing her TPS.

French said her mother’s caregiver helps with grocery shopping and laundry, and monitors her mother’s diabetes, blood pressure and diet. French said the caregiver and her mother are also companions who watch Haitian news stations together on the television. They mainly communicate in Haitian Creole, her mother’s native language.

French said she wouldn’t be able to easily find a replacement for the caregiver due to work and time constraints — and would face even more difficulty finding someone who can similarly understand her mother’s culture.

“ I don’t know how that would work, finding someone else,” French said.